MRI在颅底脊索瘤诊断中的应用价值

The diagnostic value of MRI for chordoma in the skull base

目的分析颅底脊索瘤MRI表现及其诊断价值。方法回顾性分析经病理证实的15例颅底脊索瘤的MRI影像学表现及其特点,包括发生部位、生长方式、信号特点、强化特点及与邻近结构的关系。结果搜集15例颅底脊索瘤中,斜坡型6例,蝶鞍型3例,颞枕区型2例,广泛型2例,鼻咽型1例,蝶窦型1例,肿瘤形态以类圆形分叶状为主,病灶MR表现为T1WI呈低、等、高混杂信号,T2WI以高、低混杂信号为主,增强后病灶呈轻至中度不均匀强化,病变内可有囊变、出血、钙化灶;MRI的多方位成像可以清晰显示病变位置及与邻近重要结构的关系。15例均行手术治疗,有9例术后定期随访复查提示有病变复发征像。结论 MRI可以清楚显示颅底脊索瘤的部位、大小、形态、内部结构、浸润范围及与邻近结构的解剖关系,对诊断的确定、术式的选择及术后随访的评估具有重要作用。

Objective To analyze the findings and diagnostic role of MRI for chordoma in the skull base. Methods The MRI imaging findings of 15 cases of chordoma in the skull base, which were all confirmed by pathology,were retro- spectively analyzed, including the presentation of location, growth pattern ,signal characteristics ,enhancement charac- teristics and the relationship with adjacent structures. Results Of the 15 cases of chordoma,6 were ramp type,3 were sella turcica type,2 were temporal and occipital region type,2 were extensive type, 1 was nasopharyngeal type, 1 was sphenoid sinus. As to form,most tumors were circular and lobulated. Lesions in MR imaging presented as low,equal or high mixed signal in T1WI and high or low signal in T2WI. The lesions were mild to moderate inhomogeneous en- hanced in the enhanced MRI imaging. Lesions may have cystic degeneration,hemorrhage,and calcification. Multi-di- rectional MRI imaging clearly showed the relationship between location of lesions and adjacent structures. All 15 cases underwent operation,9 of which recurred during the follow-up period of time. Conclusion MRI can clearly show the location,size, shape, and internal structure, range of invasion and adjacent structures of chordoma in skull base. It is helpful for the selection of surgical procedure and postoperative follow-up assessment.